wanderingdog

Of course the following is not medical advice nor should it be acted upon without a practitioners consultation. I'm sorry that your symptoms are making you feel out-of-control and irritable. These are classic signs of depression, not necessarily anxiety. It would be great if you could see a psychiatrist--most have sliding scale. Many larger communities also have "free clinics" for psychiatric issues. They can also provide free samples or submit you for subsidies from the drug companies. Prozac, as you probably know, is one of those "shotgun" SSRIs. It doesn't target specific receptors like some of the newer ones. It is not unusual for anyone to have "rapid" cycling with any medication. What the books say (and it is primarily addressed with clients because they will stop taking the Prozac if they don't feel their depressive symptoms leaving expeditiously) is that it normally takes 4 to 6 weeks for the full effect of the medication. We know that it has some effect within days or weeks. For this reason prescribers normally want to keep a very close eye on people just starting Prozac or other SSRIs. It is in that "ramp up" phase that people either become violent and kill themselves or others. But I'm not sure from your description if you are still taking your Prozac. For this discussion, I'm assuming you are still taking your Prozac. The pharmacodynamics of a medication is very individualistic. All the information from studies and anecdotal are gross approximations of what a drug normally does. Many people are "quick" processors and others are "refractory" to Prozac depending on their genetics and source of their depression. Many of the neurochemicals can cause depressive symptoms. There is also the placebo effect, where one-third of all clients improve on sugar pills, albeit short lived. As nurses we try to take advantage of the placebo effect by presenting the treatment in a positive fashion. So, what your expereincing could be a placebo effect early in the course of the medication and then when the med is at therapeutic levels you benefit from the medication as your placibo effect wears off. Be that as it may, except for the 80 dollars a month, why would you want to discontinue a medication that is helping you? It is not uncommon for psychiatric symptoms to increase during times of stress--similar to a diabetic who needs a change in insulin depending on stress. You have considerable room on your 30mg of Prozac to increase to the recommended max of 80mg per day (By the way, Prozac is a very good medication for anxiety disorders, if you feel you have these symptoms). This may work well, then after much of the stress, especially your youngest's transition, has passed, taper to your Prozac to the 30mg dosing. With some of the experiences you're having--not wanting to get up--you may want to consider Wellbutrin (extended release) as a supplement to the Prozac you're already taking. Wellbutrin is very good at "activating" our systems. It can give you a kickstart in the morning without the risks of stimulants and would help supplement your 30mg with your situational depression from your current stressors. Of course, the first think we look at when our symptoms increase is: SLEEP. Are you getting enough sleep? If not, with the addition of Wellbutrin, I would suggest you take something like Seroquel at 25 to 100 mgs before bed. That would help with your irritability and will allow you to go to sleep if you're anxious. Anxiety is the leading cause of "not falling asleep," while "early rising" is common with depression. Seroquel at sub-therapeutic doses for psychosis, would relieve both of these sleep problems. You have alot to sort out, but like people with diabetes, people with chronic depression shouldn't go off their medication. Chronic treatment is advised when the depression remission is less than the periods of exacerbation. It is also advised if you've had several bouts of major debilitating depression with severe suicidal ideation or acts. Medication is part of chronic treatment of psychiatric disabilties. Good luck! peace. timothy

Don't be disheartened. In all the helping professions--Nursing, medicine, social work, and psychology--the "wounded warrior" is more the norm than the exception. There is an astute observation among people with psychiatric disabilities, that there are two kinds of people with psychiatric illness--those who have been diagnosed and those who haven't. Believe me, the preference is someone who is diagnosed and actively engaged in compassionate, supportive treatment (Jung believed that all analysts should be in analysis, including himself. He once quipped that even the Pope has a confessor and not a cardinal but a parish priest. The conclusion I draw from that is that all of us in the helping profession are vulnerable and to be in analysis allows us to reflect and assure that a trusted professional is watching to ensure there isn't a failure of transferrence, ethics, or individual symptoms--including our own fixed delusions about what nursing is and who should practice it). Indeed, the dangerous people--in nursing or any other profession--are people who have psychiatric illness and are not being treated because they haven't been diagnosed. Very reputable evidence confirms that, practitioners in primary care, miss over half of the people with psychiatric symptoms. And the only place you would be diagnosed is in the primary care setting, because people won't go to psychiatrists with symptoms (due to stigma). Florence Nightengale was bipolar, and is the epitomy of a nurse who had the heart, mind, and skills to serve her "boys." She was houseridden so much during the exasperations of her illness, that her dreams and desires for the profession weren't entirely realized. She was, however, always a force--even when very sick--in the substanative and more importantly, in my mind, the political emancipation and development of nursing outside of medicine's greedy clutches. Freud had some real issues with depression and substance abuse, and probably bipolar. Jung was no doubt bipolar, if not at times psychotic. There is no way anyone could produce as much as he did without being manic most of the time. Much of his deep pscyhology are very reminiscent of psychotic breaks. Unlike the movies, breaks with reality are usually not permanent and many people, including Maslow and Campbell, believe that the psychotic break is as much a spiritual experience as it is a psychiatric experience. Indeed, the complete psychotic break is a bonafide spiritual and psychiatric emergency, but felt by many to be a developmental stage to higher consciousness. If one percent of the adult population experience bipolar every year (about 12 million people), you can be sure that at least one percent of nurses deal with bipolar every year (most undiagnosed and untreated). You can refer to your DSM, but I believe the best definition of bipolar was, indeed, from someone who wrestles with it: "Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide." "I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do." Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6. Kay is in the helping professions and if she had waited for her bipolar to "be controlled" she wouldn't have received the education and experience needed to be a compassionate, wounded warrior to others in crisis. She continues to this date to wrestle with her symptoms. Would you ask a nurse with diabetes to not work with diabetics until her diabetes was controlled. The journey and the techniques to control diabetes are from day-to-day. Everyone of us nurses could end up with a disabling condition, mostly back injuries, that is why we carry short- and long-term disability. The exacerbations of psychiatric symptoms that are no longer responsive to current therapy isn't a reason to not pursue your passion. I am a person who is an excellent nurse and lives with schizoaffective disorder. I graduated with a BS in nursing with a 3.8 gpa, critical care internship, and inducted into the Honor Society of Nursing, Sigma Theta Tau International. During all this time I was actively engaged with my treatment team and we continue to treat my symptoms while I work 32 to 70 hours a week. In addition, I'm a graduate student in nursing. My advice to you, as an expereinced bedside nurse and a fellow person suffering from a psychiatric disability, is march on with a vengence. Take care of today. Ensure you invoke the ADA at school and at work if necessary, but don't advertise that you have a psychiatric disability--AS YOU READ in some of these postings, THE STIGMA OF MENTAL ILLNESS IS STILL STRONG. Sometimes the stigma results in discrimination--don't let the discrimination get in your way, fight it with legal action if necessary. This can be very burdensome for your symptoms and progress in nursing. As an alternative, if your school doesn't support people with psychiatric disabilities, find another school where the Dean and faculty are supportive. Find someone, preferrably the Dean, who can be a champion for people with disabilities. Be honest with this champion and be honest with yourself about the course and demands of your disability, but don't let anyone stop you from becoming a nurse. First of all it's illegal, but even more important it's the right thing. Concerning your thoughts about psychiatric nursing, if you've had a clinical in psych and that went well, why would you be concerned about working day-to-day with that cohort? I remember the first day that the hospital gave me the key to the psychiatric hospital where I did my clinical. My first thought was, "Wow, they gave me the key!" Caring for people with psychiatric disabilities is an awesome responsibility. These people are in the most vulnerable situation where abuse and maltreatment can occur. As an RN, you would be in a position to have an impact on the way people with psychiatric disabilities are treated in your milieu. I couldn't think of anyone who would be a better advocated than an RN who has personal experience of being stigmatized, abused, and maltreated because you have a psychiatric disability. You are still on the beginning of your journey. You may find that you don't like psychiatric nursing. That's the great thing about our profession, unlike medicine, you can move from one specialty to another in a rather seamless fashion. I've made many moves into different specialties--critical care, acute med/surg, and psych. Each move, unlike Benner's ridiculous theory, isn't a start from the beginning. Now I care for geriatrics who have co-morbid psychiatric, medical, and/or neurological conditions. This blended role is very satisfying to me and profoundly needed in our communities. Good Luck! Peace. timothy